title: Neuromodulation of vegetative state through spinal cord stimulation: where are we now and where are we going?
abstract: BACKGROUND
  Vegetative state (VS) is a complex condition that represents a challenging frontier for medicine and neuroscience research. Nowadays there is no scientifically validated treatment for VS patients, and their chronic long-term assistance is very demanding for healthcare systems worldwide.
  
  
  OBJECTIVE
  The present paper is a systematic review of the role of spinal cord stimulation (SCS) as a treatment of patients with VS.
  
  
  METHODS
  Published literature on this topic was analyzed systematically. Clinical and epidemiological characteristics of VS, present therapeutic options and social costs of VS were also evaluated.
  
  
  RESULTS
  Only 10 papers have been published since 1988, and overall 308 VS patients have been treated with SCS worldwide; 51.6% displayed a clinical improvement and an amelioration of the environmental interaction. These effects are probably mediated by the stimulation of the reticular formation-thalamus-cortex pathway and by cerebral blood flow augmentation induced by SCS.
  
  
  CONCLUSIONS
  The experience on this topic is still very limited, and on this basis it is still hard to make any rigorous assessment. However, the most recent experiments represent significant progress in the research on this topic and display SCS as a possible therapeutic tool in the treatment of VS.
authors.affiliation: Institute of Neurosurgery, Catholic University of Rome, Rome, Italy.
authors.forename: Giuseppe Maria
authors.initials: GM
authors.lastname: Della Pepa
authors.forename: Chikashi
authors.initials: C
authors.lastname: Fukaya
authors.forename: Giuseppe
authors.initials: G
authors.lastname: La Rocca
authors.forename: Jun
authors.initials: J
authors.lastname: Zhong
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Visocchi
mesh_terms: D001143:Arousal / Q000502:physiology; D002540:Cerebral Cortex / Q000503:physiopathology; D002560:Cerebrovascular Circulation / Q000502:physiology; D017281:Cost of Illness; D005060:Europe / Q000453:epidemiology; D006801:Humans; D008483:Medical Assistance / Q000191:economics; D009313:National Health Programs / Q000191:economics; D018579:Patient Selection; D018458:Persistent Vegetative State / Q000191:economics / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D020127:Recovery of Function; D012154:Reticular Formation / Q000503:physiopathology; D062187:Spinal Cord Stimulation / Q000639:trends*; D013788:Thalamus / Q000503:physiopathology; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology